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Identifier 000417169
Title Παράγοντες που επηρεάζουν την ενδονοσοκομειακή θνητότητα και την επανεισαγωγή στη ΜΕΘ ασθενών μετά από εξιτήριο από τη ΜΕΘ : Αναδρομική μελέτη στη ΜΕΘ του Πα.Γ.Ν.Η.
Alternative Title Factors that affect in-hospital mortality and ICU readmission rate after discharge from the Intensive Care Unit
Author Παπαδάκης, Ελευθέριος
Thesis advisor Κονδύλη, Ευμορφία
Reviewer Βαπορίδη, Αικατερίνη
Abstract The in-hospital mortality and ICU readmission of patients after ICU discharge are the major adverse events of these patients. In the literature, in-hospital mortality ranges from 2% to 12%, while the incidence of ICU readmission has been estimated at 1.3% -13.7% after ICU discharge. The poor prognosis of patients readmitted into the ICU (higher mortality and overall days of hospital stay) and the fact that patients dying in hospital after multi-day stay in ICU are a source of increased cost without the desired effect. The factors that have been shown to contribute to the ICU readmission of patients and the in-patient death of patients after discharge from the ICU concern the patients themselves and their clinical status, interventions and events during their stay in the ICU and various organisational factors in their management. Due to the multifactorial reasoning of these outcomes, it is difficult to use these rates as quality indices for comparison of hospitals. However, it is necessary to implement measures to reduce in-hospital deaths and ICU readmission by implementing specific guidelines for the admission and discharge of patients from the ICU and the implementation of transition programs resulting in a smoother transition of patients to the general hospital wards. Objectives. The purpose of this study is to assess the rates of readmissions in ICU and the in-hospital mortality of patients after ICU discharge in the same hospital stay and to identify the risk factors that affect the above percentages at the University Hospital of Heraklion. Methodology. This retrospective study of recording of data from electronic databases of hospital systems. We studied the patients admitted to the ICU from 01/01/2016 until 31/12/2016 and were discharged from the ICU and was able to observe their course. Factors related to the characteristics of the patients, the cause of admission, the clinical status of the patients during their admission and their discharge from the ICU, and data from the patients' stay in the ICU were studied. Results. In this study, the incidence of ICU readmission of patients after discharge from the ICU of University Hospital of Heraklion was calculated at 9.8%. the in-hospital mortality in this group of patients was 11.8%. The factors that differentiate to a statistically significant degree between the group of patients who were discharged from the hospital and those 12 who died in the hospital clinics or readmitted to the ICU within 7 days of their discharge from the ICU is the septic condition at patient during their first admission, patient out of ICU with tracheostomy, new infection during patient hospitalization in ICU, SAPS II score on patient first ICU admission, Charlson Comorbidity Score of the patient as calculated on patients’ ICU admission and the incidence of diabetes mellitus and metastatic cancer which are increased in patients who die in the hospital or are readmitted on the ICU. To a statistically significant degree, we found a difference in the mean value of CRP and hemoglobin among the outcomes groups. There was no correlation between discharge off-hours or on weekends, duration of usage of vasoconstrictive agents, or implementation of mechanical ventilation during ICU stay and outcome of patients. Conclusion. Both in-hospital mortality and the incidence of readmission in the ICU of patients who have been discharged from the ICU of University Hospital of Heraklion appear to be comparable to those published in the international literature . It should be noted, however, that there is scope for improvement by implementing measures such as the adoption of a transition program for patients in general clinics. Also, factors related to the severity of the patients' condition during their admission and during their stay in the ICU, their comorbidity and their status on ICU discharge are related to their outcome after leaving the ICU. To improve patient safety, ICU physicians should take these factors into account when making intensive care discharge decisions.
Language Greek
Subject Μονάδα εντατικής θεραπείας
Issue date 2018-07-18
Collection   Faculty/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
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